Provider Demographics
NPI:1346458536
Name:CARTER, SUSAN E (PHD)
Entity Type:Individual
Prefix:DR
First Name:SUSAN
Middle Name:E
Last Name:CARTER
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:428 HARRISON AVE
Mailing Address - Street 2:SUITE 101A
Mailing Address - City:CLAREMONT
Mailing Address - State:CA
Mailing Address - Zip Code:91711-4605
Mailing Address - Country:US
Mailing Address - Phone:909-593-6754
Mailing Address - Fax:
Practice Address - Street 1:428 HARRISON AVE
Practice Address - Street 2:SUITE 101A
Practice Address - City:CLAREMONT
Practice Address - State:CA
Practice Address - Zip Code:91711-4605
Practice Address - Country:US
Practice Address - Phone:909-621-2819
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFT17249106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist